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Hi Kathy!
D9223 - deep sedation/general anesthesia — each 15-minute increment D9612 - therapeutic parenteral drugs, two or more administrations, different medications can be crosscoded to: 00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified 00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate 00174 - Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor 00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery 01999 - Unlisted anesthesia procedure(s)
D7210 - surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D7220 - removal of impacted tooth - soft tissue
The codes listed above do not have direct crosscodes we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT code below and include a narrative report describing the procedure: 41899 - Unlisted procedure, dentoalveolar structures
As for the office visit:
Here are the options below for new and established patient visits:
New patients:
99201 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family
99203 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family
99205 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
Established Patients:
99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
99212 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family
Hope this helps!
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Hello,
I worked in Dental for many years but have been away now for 10. My son is having oral surgery in the morning for wisdom teeth.
My ins, UHC wants all extractions billed through them before dental...here is the problem...
UNITED HEALTH CARE Will cover the surgery done is Oral Surgeons Office 100% IF and here is the BIG IF....THE claim is filed as an OFFICE VISIT with surgery done in office and NOT in surgical center. That is exactly where the surgery is going to take place. However, the OS office seems clueless as to what correct medical code to file in order for my insurance to cover 100%!
If they do not include this code, I will be out $2000!!!!
Here is what he is having done, in office:
D9223 (4 charges) of $217....which I truly don't understand since they are only putting him under once and the treatment plan does not specify time? Maybe it is per 15 mins or so.... D9612 Therapeutic drugs 2 + admin $125 D7210 (2 charges) $365 each Surgical Extraction of 1 & 16 D7220 (2 charges) $380 each Soft Tissue Extraction of 17 & 32
Other than submitting this on a medical claim form, should the OS office change these codes to reflect medical codes?
Also, what is the correct code for the office visit and when the procedure is done in the office of the OS?
Please help ASAP, he has surgery tomorrow morning! Sorry for the late request!
Sincerely,
Kathy Gatewood
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